tobramycin sulfate
Tobramycin is an antibiotic that's used to treat several types of bacterial infections. It used to be known as the brand name Nebcin, but is now only available under the generic name tobramycin. This medication is usually given as an intravenous or IV injection into the veins in the hospital or at your provider's office. While side effects aren't common, tobramycin has serious potential risks, such as hearing loss and kidney problems. To lower your risk, your provider will closely monitor your dosage, hearing, and kidney health and measure the level of tobramycin in your blood.
What is Tobramycin?
What is Tobramycin used for?
Sepsis due to a bloodstream infection
Lower respiratory tract infections (e.g., pneumonia, bronchitis)
Brain and spinal cord infections (e.g., meningitis)
Skin infections (e.g., cellulitis)
Urinary tract infections (UTIs)
How Tobramycin works
Tobramycin is an aminoglycoside antibiotic. It works by preventing bacteria from making certain proteins. As a result, the bacteria can't survive and spread throughout your body.
Drug Facts
What are the side effects of Tobramycin?
Common Side Effects
- See Other Side Effects.
Other Side Effects
- Nausea
- Vomiting
- Diarrhea
- Headache
- Low energy
- Confusion
- Itching
Serious Side Effects
- Nervous system side effects: hearing problems, ringing in the ears, dizziness, numbness, tingling, muscle twitching
- Serious kidney problems: tiredness, dry and itchy skin, low appetite, urinating less than usual, foamy or bloody urine, muscle cramps
- C. difficile-related diarrhea: fever, stomach pain or cramps, foul-smelling diarrhea, frequent bowel movements (up to 15 times per day),
- Serious allergic reaction: hives, rash, blisters, skin reddening, swelling of the lips or tongue, difficulty breathing
Source:Â DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Less common
Itching, redness, swelling, or other sign of eye or eyelid irritation not present before use of this medicine
Symptoms of overdose
Increased watering of the eyes
itching, redness, or swelling of the eyes or eyelids
painful irritation of the clear front part of the eye
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
Burning or stinging of the eyes
Eye ointments usually cause your vision to blur for a few minutes after application.
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Tobramycin
Pros
Works well to treat infections caused by many types of bacteria
Can use for adults and children
Dosage is carefully adjusted by your provider
Cons
Might need to be given as often as every 6 hours
Requires close monitoring of blood tobramycin levels to check how well it's working and for safety
Might worsen medical conditions such as kidney, nervous system, hearing, or muscle problems
Pharmacist tips for Tobramycin
Make sure your provider knows about all the medications you take, especially diuretics (water pills) or other antibiotics. Certain medications can interact with tobramycin and raise your risk for kidney damage.
Tobramycin can cause diarrhea. In general, it should go away when you stop taking the antibiotic. But call your provider as soon as possible if you start having watery or bloody diarrhea, fever, fatigue, or stomach cramps anytime during treatment or after stopping tobramycin. These can be signs of serious infectious diarrhea that needs to be treated right away.
Seek medical help right away if you experience any confusion, ringing in the ears, hearing loss, muscle twitching, tingling, or seizure. These could be signs of nervous system side effects from tobramycin.
Contact your provider if you develop other symptoms of an illness or if your symptoms become worse. Tobramycin can only treat infections caused by bacteria, so it won't help if you have an infection caused by a virus or fungus.
Tips for using tobramycin at home (if instructed by your provider):
If you need treatment with tobramycin for a long time, it's possible that your provider might let you take the medication at home. If so, make sure to follow your provider's instructions carefully so you use tobramycin properly and safely. Your provider might instruct you to use vials of the medication that need to be mixed and prepared for administration.
If you're using tobramycin at home for long-term treatment, make sure to set a reminder for your doses. It's important to get all of your doses of tobramycin and finish your treatment course, even if you feel better. Otherwise, your infection might get worse or become harder to treat.
Mark your scheduled provider visits and blood work appointments on your calendar. This will help your provider make sure that tobramycin is treating your infection and that it's as safe as possible for you.
Frequently asked questions about Tobramycin
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What are the risks and warnings for Tobramycin?
Tobramycin can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk of nervous system side effects and hearing loss
Risk factors: History of brain, nervous system, or hearing problems | Taking other medications that cause nervous system or hearing problems | Taking too much tobramycin | Premature and newborn babies | Older age | Dehydration (low fluids in the body)
Tobramycin can cause nervous system problems, including dizziness, numbness, tingling, muscle twitching, and even seizures. Tobramycin can also cause ringing in the ears or permanent partial or total hearing loss, typically in both ears. Your risk is higher if you're also taking medications that can cause hearing loss, such as diuretics (e.g., furosemide (Lasix)). Depending on how long you need tobramycin treatment, your provider might test your hearing regularly throughout treatment. Seek medical help right away or contact your provider if you notice changes in your hearing, numbness, tingling, or muscle twitching. They can help you manage these effects.
Kidney problems
Risk factors: History of kidney problems | Taking other medications that cause kidney problems | Taking too much tobramycin | Premature and newborn babies | Older age | Dehydration (low fluids in the body)
Tobramycin can damage the kidneys. Sometimes, kidney damage can cause your body to not make urine as well. Your risk is higher if you're also taking other medications that can harm your kidneys. Your provider will check your kidney health through urine and blood tests while you're getting treated with tobramycin. They'll adjust the dose or stop the medication if it's hurting your kidneys. Contact your provider if you notice signs or symptoms of kidney problems, such as tiredness, dry and itchy skin, low appetite, urinating less than usual, foamy or bloody urine, muscle cramps.
Risk of harm to unborn babies
It's possible for aminoglycoside antibiotics like tobramycin to cause harm to unborn babies, such as hearing loss. Because of this risk, make sure your provider is aware whether you're pregnant before starting tobramycin treatment if possible. Depending on your infection and your risk factors, your provider might consider using a different antibiotic from tobramycin.
Serious allergic reactions
Risk factors: Allergy to sulfites
Serious allergic reactions to tobramycin are possible, including life-threatening reactions like facial swelling, shock, and anaphylaxis (e.g., closing of the throat). It's also possible to have severe skin reactions to the medication. Additionally, some tobramycin products contain an ingredient called sulfite. Certain people might be sensitive to sulfite and have an allergic reaction to it. Depending on your reaction, your provider might switch you to another antibiotic. Call for help right away if you notice hives, peeling or blistering skin, difficulty breathing, a choking sensation, swelling around your eyes, swelling of the lips or tongue after using tobramycin.
Diarrhea from Clostridioides difficile infection
Antibiotics, including tobramycin, raise your risk of getting infected with a bacteria called Clostridioides difficile (C. diff). This infection can cause diarrhea that can sometimes be life-threatening. Antibiotics change the amount of normal bacteria in your stomach and intestines. This can cause C. diff to overgrow in your gut and lead to an infection.
This type of infectious diarrhea is different than the diarrhea you might get as a possible side effect of tobramycin. C. diff-related diarrhea can cause rapid heart rate, fever, nausea, foul-smelling diarrhea, bloody stools, or frequent bowel movements (even up to 15 times per day). This is a medical emergency, so get medical attention right away if you experience any of these symptoms. You'll get tested for C. diff infection and receive treatment, if needed.
Development of drug-resistant bacteria
Your provider will monitor your treatment with tobramycin to make sure you're taking the antibiotic for the appropriate infection and amount of time. Using tobramycin for any shorter or longer periods of time or taking the antibiotic for other illnesses can raise your risk for developing infections caused by drug-resistant bacteria. This raises your risk for severe and life-threatening infections that might be difficult to treat.
Tobramycin dosage forms
Typical dosing for Tobramycin
Tobramycin is given as an infusion into the veins (intravenous or IV) or injection into the muscle (IM). It's given by a provider in a healthcare setting (e.g., hospital, office, nursing home).
This medication is given anywhere from every 6 hours to every 12 hours. Sometimes, providers give tobramycin every 24 hours.
Your dose and how often you need tobramycin injections depend on your age, your weight, what type of infection you have, how serious it is, whether you have kidney problems, and your tobramycin blood level. Your provider will find the right dose and treatment schedule for you.
Interactions between Tobramycin and other drugs
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Ataluren
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Alcuronium
- Atracurium
- Cholera Vaccine, Live
- Cidofovir
- Cisatracurium
- Colistimethate Sodium
- Decamethonium
- Doxacurium
- Ethacrynic Acid
- Fazadinium
- Foscarnet
- Furosemide
- Gallamine
- Hexafluorenium
- Lysine
- Mannitol
- Metocurine
- Mivacurium
- Pancuronium
- Pipecuronium
- Rapacuronium
- Rocuronium
- Succinylcholine
- Tubocurarine
- Vancomycin
- Vecuronium
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Tobramycin contraindications
Allergy to any aminoglycoside antibiotic
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References
Best studies we foundAmerican Academy of Allergy, Asthma, and Immunology. (n.d.). Sulfite and sulfa drugs.
Baxter Healthcare Corporation. (2023). Tobramycin injection [package insert]. DailyMed.
Bush, L. M. (2023). Pseudomonas infections. Merck Manual Consumer Version.
Centers for Disease Control and Prevention. (2010). Klebsiella pneumoniae in healthcare settings.
Centers for Disease Control and Prevention. (2022). E. coli (Escherichia coli).
Colston, J., et al. (2018). Bone and joint infection. Clinical Medicine.
Grennan, D., et al. (2019). Home intravenous antibiotic therapy. Journal of the American Medical Association.
Krause, K. M., et al. (2016). Aminoglycosides: An overview. Cold Spring Harbor Perspectives in Medicine.
Lopez, N., et al. (2011). A comprehensive review of abdominal infections. World Journal of Emergency Surgery.
Naber, K. G., et al. (1973). Pharmacokinetics of the aminoglycoside antibiotic tobramycin in humans. Antimicrobial Agents and Chemotherapy.
Norris, A. H., et al. (2019). 2018 Infectious Diseases Society of America clinical practice guideline for the management of outpatient parenteral antimicrobial therapy. Clinical Infectious Diseases.
Pandey, N., et al. (2023). Beta-lactam antibiotics. StatPearls.
Reddy, P. (2016). Empiric antibiotic therapy of nosocomial bacterial infections. American Journal of Therapeutics.Â
Reyhanoglu, G., et al. (2023). Tobramycin. StatPearls.
Stankowicz, M. S., et al. (2015). Once-daily aminoglycoside dosing: An update on current literature. American Journal of Health-System Pharmacy.
Tamma, P.D., et al. (2023). IDSA 2023 guidance on the treatment of antimicrobial resistant Gram-negative infections. Clinical Infectious Diseases.
Wong, G., et al. (2014). How do we use therapeutic drug monitoring to improve outcomes from severe infections in critically ill patients? BioMed Central Infectious Diseases.
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